Rotator Interval Closure

If after repair of the labrum and IGHL and MGHLs, the shoulder shows persistent inferior or inferoposterior translation, rotator interval closure is performed. The authors close the rotator interval in all patients with MDI and posterior instability.

The arthroscope is inserted posteriorly to visualize the rotator interval. The arm should be placed in external rotation and a curved shuttling device (example, spectrum, Linvatec, Largo, FL), suture hook, spinal needle, or penetrating instrument (penetrator, Arthrex, Naples, FL) is placed directly through the anterosuperior cannula or percutaneously through the portal without the cannula. The instrument is then advanced through the robust capsular tissue immediately superior to the subscapularis tendon. The suture or shuttle is then advanced into the joint.

The cannula is backed out of the joint, the penetrating instrument is then passed through the strong tissue just anterior to the supraspinatus tendon. The suture or shuttle is then grasped. Both sutures limbs are then retrieved out of the anterosuperior cannula. A crochet hook can help can help in this retrieval. The sutures are then tied blindly and extra-articularly. Additional sutures may be added as needed.